In his talk Mr. Orozco briefly described some key
elements of “fad” diets to beware of:

A magic bullet (i.e. the hormone HCG, which,
when given with a 500 kcal per day diet, results in weight loss)

Diet phases or stages, such as “Rapid Detox” and
“Maintenance” phases

Celebrity testimonials and endorsements

Medical professionals agree that the DASH diet
and the Mediterranean diet have the most scientific evidence to back up their potential
benefit in terms of health related outcomes such as hypertension and metabolic
syndrome.
These two diets are also ranked #1 and #2 respectively by a US News ranking of "Best Diets."WebMD’s diet comparison tool comes very highly recommended if you are sorting through diet options.

However, Mr. Orozco advocates a
different approach to dieting: “Intuitive Eating,” or “Mindful Eating.” These conceptsinvolve gaining an understanding of one’s relationship with food and then healing
it, such that an individual gains a heightened responsiveness to his or her own
body signals.The premise, a kind of psychotherapeutic
approach, is that intuitive eating will result in better food equilibrium and
eventual healthy weight maintenance. I’ll
admit that I have not yet read the book, but am eager to do so.

As I listened to the talk, I
brought to the table my own perspective—I have never struggled
with my weight, I am a relatively compulsive exerciser, and I enjoy
cooking and eating out.Exercise alone has been shown
to be an effective technique to help with weight
maintenance.My personal experience
(I’ve been about the same weight since age 18) is testimony to this. However, the
one time that I did lose 15 pounds, I did it through calorie counting.Since then (twenty years ago), I’ll admit
that I do have a conscious awareness of the caloric value of most food that I
ingest.Do I eat chips, chocolate, an
occasional Quarter Pounder and fries? Absolutely; but when the scale tips up
five pounds I am quick to take action and cut back.For dinner tonight—homemade lentil soup with
kielbasa, bacon, and carrots, brown rice, green salad with blue cheese, and a
glass of Argentine Malbec; for dessert: a
sliver of lemon pound cake topped with coconut gelato.

I have found that with my patients who want to achieve more
than ten pounds of weight loss, a structured approach is essential—a specific action
plan.Vague plans to cut back
and “eat healthier” tend not to be effective. Over the years I have asked my patients who have successfully lost weight what their strategy was. Though the strategies that my patients describe are as diverse as are the array of diets on the market, a common thread seems that those who have been successful are able to articulate a clear plan of action that led to the weight loss.

I am an advocated of calorie counting and Weight Watchers (whose point
system is essentially like calorie counting).My viewpoint is that for weight loss, it’s not so much the content of
the food that matters, but rather the quantity and caloric value.However, there is some evidence that low carbohydrate diets may produce more weight loss than very low fat diets (i.e. the
Ornish Diet) though this finding has not yet been definitively proven. A pound
of fat is equal to 3500 kcal. It’s hard to lose more than a pound of fat every
7 to 10 days, and I don’t recommend it.I personally consume about 2000-2500 kcal per day (with 30-60 minutes of
exercise on most days).

Here are some of my own weight loss tips:

Eat smaller portions, but don’t skip meals

Count and record your calories for at least 1-2 weeks when
you begin to diet

Don’t reduce your caloric intake by more than 500 kcal per
day below baseline intake (it’s too hard to maintain)

Don’t drink diet drinks and don’t drink any beverage all day
long (including water)

Do have coffee or tea following a meal if you are not quite
satisfied

Do enjoy a mealtime ritual at least once a day-- set the
table and play some music while you dine, enjoy your oatmeal and coffee while
reading the paper

Don’t eliminate your favorite food, save it as a treat a day
or two per week

Treat yourself to
meals out, but split your portion with a companion or eat an appetizer instead
of an entree

Exercise 3-4 times per week, but keep in mind that adding
exercise alone rarely works to achieve more than 5 to 10 pounds of weight loss

Don’t chastise yourself if you are unable to exercise, most
of weight loss comes through alterations in one’s diet not through exercise

Cook at least three times per week using whole food
ingredients and cook enough for two meals so that you can have leftovers

Pack your lunch and bring it to work

Once your desired weight loss is reached, this is where intuitive
or mindful eating becomes important—retraining oneself toward a healthier relationship
with food.Weight maintenance is the
hard part. Some of you may have read a recent New York Times Magazine cover article
entitled “The Fat Trap” by weekly health columnist and author of the NYT "Well" blog Tara Parker-Pope.Ms. Parker-Pope makes the case that powerful metabolic and hormonal factors
make it very difficult to maintain weight loss.I personally find Ms. Parker-Pope’s viewpoint overly nihilistic, though
she brings to light interesting information. A petitioned response to Ms. Parker-Pope’s
piece, authored Gary Taubes and Peter Attia, MD, argues that Ms. Parker-Pope’s
article neglected the important effect of insulin resistance on obesity.The authors maintain that restriction of
refined carbohydrates, as opposed to overall caloric restriction, can allow
overweight patients to successfully bypass some of the metabolic impediments to
weight loss by reducing insulin resistance, while all the while suppressing
hunger through increased protein and fat consumption.Indeed there is some medical evidence to support low carbohydrate diets.

In my own practice I have seen numerous
patients lose weight successfully.The metabolic
effects on cholesterol, blood sugar and blood pressure are typically profound. Remember, if you are overweight or obese,
weight loss in itself is as important of a goal as is healthy eating.

How did you lose weight? Were you able to maintain it? What
do you think of the intuitive eating concept? I welcome you to share your own
lessons and help others.

*To learn more about
intuitive eating contact David Orozco RD of T+D Wellness in Atlanta at 404-228-9704.

3 comments:

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

I believe that avoiding ready-made foods may be the first step to lose weight. They can taste great, but highly processed foods include very little nutritional value, making you feed on more just to have enough electricity to get over the day. If you are constantly eating these foods, transferring to whole grains and other complex carbohydrates will help you have more vitality while consuming less. Great blog post.

My Medical Practice

About Me

I am a general internist, otherwise known as a primary care physician for adults. I grew up in Ann Arbor, Michigan, attended medical school at the
University of Michigan, and completed my residency training in internal
medicine at the University of Washington in Seattle. After my training I spent 12 years in practice at Emory University in Atlanta, where I served as clinician and teacher of medical residents. In my role as Director of Clinical Outcome Improvement at The Emory Clinic in General Medicine I developed expertise in the field of quality improvement. In particular, I led work to improve care for patients with chronic illness. This work fostered my interest in innovative models of primary care
delivery. In 2010 I founded Personalized Primary Care Atlanta, where I
currently practice.

I enjoy the full scope of general internal medicine and
during time off from clinical practice have found myself surfing the web to
read and stay current with medical information. For this reason I have chosen
to create my medical blog "DrDialogue," a conversation about health
topics for both patients and health professionals.